Who Are Asthma Specialists and What Do They Do?
Allergist-Immunologist It’s common for people with asthma to also have allergies; the same allergens that can set off your hay fever — such as pollen, dust mites, and pet dander — can trigger asthma symptoms. An allergist-immunologist is a physician who is specially trained to identify asthma and allergy triggers, and can diagnose asthma and other allergy-related diseases. Your allergist-immunologist may conduct allergy and breathing tests to find the cause of your asthma. Allergists-immunologists can do a deep-dive investigation into what could be causing your breathing problems. “We now understand that asthma in many patients has an underlying inflammation,” says Alan Goldsobel, MD, an allergist-immunologist at Allergy and Asthma Associates of Northern California in San Jose. Working with this type of asthma specialist can make a difference in how well you manage your asthma: According to the American Academy of Allergy Asthma & Immunology (AAAAI), studies have shown that asthma patients who are treated by an allergist have fewer asthma flare-ups and emergency room visits. Pulmonologists Pulmonologists are physicians who specialize in treating the respiratory system, and some pulmonologists sub-specialize in specific conditions, such as asthma or chronic obstructive pulmonary disorder (COPD). Pulmonologists often work in hospital settings, with patients who have serious or chronic breathing problems. Your pulmonologist may be able to connect you to other asthma specialists, such as respiratory therapists, if they feel it may benefit your asthma treatment. Allergist-immunologists, who specialize in allergies and asthma, and pulmonologists, who handle respiratory diseases like asthma, have had years of additional training in this field and are generally more experienced in asthma management and treatments than nonspecialists. “They are already focused on this disease,” says Jacqueline A. Pongracic, MD, the head of allergy and immunology at Ann & Robert H. Lurie Children’s Hospital of Chicago and a professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine. Allergist-immunologists and pulmonologists may help you manage your asthma through their expertise in the following areas: Finding Triggers, Evaluating Treatment, and Tracking Progress Allergists can perform allergy tests to identify triggers, such as mold, pollen, dust, and animal dander, and educate patients on how to avoid them. An asthma specialist can take a thorough history, teach inhaler techniques, monitor your therapy, and make attempts to step down therapy as you progress, says Todd Rambasek, MD, an allergist-immunologist at University Hospitals Cleveland Medical Center in Ohio, and a fellow of the AAAAI. Knowing About the Latest Asthma Medication Asthma specialists are knowledgeable about medication that other physicians might not be, says Dr. Pongracic. Drugs like monoclonal antibodies — omalizumab and mepolizumab, for example — are generally prescribed only by specialists, she says. These meds are used to modulate the immune system and suppress the body’s response to asthma triggers to better control asthma. Having Access to the Latest Diagnostic Tools Allergist-immunologists and pulmonologists also have tools to measure lung health that primary care physicians might not. “An allergist or pulmonologist would be more likely to have special equipment to help assess [your] current lung function,” says Pongracic. Moreover, an asthma specialist can keep track of how responsive your lungs are to treatment, and can help predict your future treatment. Staying up on New Advances in Asthma Care Asthma specialists keep up with the latest developments in asthma care, prevention, and treatment, and are on the lookout for contributory conditions. For instance, asthma doctors are increasingly realizing that nasal conditions are an important component of asthma treatment, says Pongracic. A specialist can help manage asthma by also treating, say, chronic sinusitis. Working With You to Manage Asthma — Not Just Responding to Flares Specialists can help you do more than just manage symptoms — they can help you live your best life while controlling your asthma. Just because you have asthma doesn’t mean you can’t play tennis or run a marathon, Dr. Rambasek says, adding, “Don’t accept that you can’t do these things.” For instance, you may need a specialist for immunotherapy. “Sometimes you can’t avoid things that can set off asthma, such as grass or pollen,” says Pongracic. “You have to go outside.” If that’s the case, you may need to see an allergist who is trained to administer allergen immunotherapy, in which a series of injections or sublingual immunotherapy (aka SLIT, whereby small doses of an allergen are given under the tongue to boost tolerance of the substance and reduce symptoms) is used to help manage symptoms. RELATED: 5 Ways to Manage Your Asthma Triggers
Signs You May Need to See an Asthma Specialist
If your asthma is very mild or well-controlled, you may only need to rely on your primary care physician. “Many people with asthma in the United States have their asthma treated by a primary care provider, and most of the time, you’ll get pretty good care,” says Dr. Goldsobel. But if you’re experiencing persistent asthma attacks or your symptoms are reoccurring frequently, you may need an asthma specialist. If any of these scenarios apply to you, you should seek the care of an allergist-immunologist or a pulmonologist:
Your symptoms aren’t well controlled, aren’t getting better with treatment, or are negatively affecting your quality of life.You’re getting injectable or oral steroids more than once or twice a year. “This is not considered good control,” says Rambasek.You’re hospitalized or have to go to urgent care or the emergency room for asthma three times a year or more.You experience side effects from asthma medication, such as growth suppression (in children), oral thrush, emotional changes, osteoporosis, or weight gain.
To find an asthma specialist, check out the AAAAI website, which lists providers by region. Your primary care physician may also be able to offer recommendations. When searching for an asthma doctor, look for someone who is board-certified (as the doctors on the AAAAI website are), and if possible, try to find someone who is appropriate for your age group (for instance, a pediatric allergist would likely be the best choice for a child). RELATED: 7 Ways Your Doctor Can Help You if Your Asthma Treatment Isn’t Working
How You and Your Asthma Doctor May Work Together to Treat Your Asthma
After receiving a diagnosis of asthma, you’ll probably see your asthma specialist as often as once every two to six weeks. When your asthma is under control, you may be able to drop your appointments down from once a month to a couple of times a year. Some things you can expect from your asthma management:
You may need to keep a detailed record of your symptoms with an asthma action plan. For example, logging data from a peak flow meter (which measures lung capacity), tracking your daily symptoms, and jotting down any triggers that you might have encountered can help you better manage your condition and can give your doctor a clear impression of how you’re doing.You may be prescribed long-term (or controller) medication: These medicines can help you control your condition over the long term by helping to reduce airway inflammation, thus lessening the risk of asthma symptoms. The most effective, commonly used drugs are inhaled corticosteroids; others include cromolyn (taken by means of a nebulizer), omalizumab (given via injection), inhaled long-acting beta2-agonists (used along with inhaled corticosteroids), and leukotriene modifiers and theophylline (both taken by mouth). Since many of these drugs have side effects, your doctor will help you monitor how well you’re tolerating them.You will also be given quick-relief medication. Also called “rescue” medicines, short-acting beta2-agonists are often prescribed by doctors to open up the airways quickly in the event of an asthma flare-up. This type of medicine, delivered through an inhaler (or a nebulizer), must be carried at all times by anyone who has asthma. “We generally always prescribe quick-relief medication,” says Pongracic, “because even people with mild symptoms may suddenly encounter triggers.”During follow-up visits, your doctor will ask whether your asthma symptoms are under control, if your symptoms awaken you during the night, if you’ve had to visit an urgent care or emergency room for symptoms, whether you’ve had any problems with your medication, or if you have any concerns about your treatment. Depending on how well your treatment is working, your doctor may want to change the type of medication you’re taking or adjust its dosage.
Using Tech to Connect to an Asthma Specialist
Finally, if you don’t live near an allergist or pulmonologist, you might want to consider making an appointment with a specialist by means of telemedicine — that is, videoconferencing technology that allows the doctor to see and hear you in real time, listen to your heart and lungs with a digital stethoscope, and examine your ears and nose with a digital otoscope. A study published in September 2016 in the Annals of Asthma, Allergy, and Immunology found that such “visits” were as effective at treating children with asthma as in-person visits. Whether you opt for an in-person visit or a telemedicine consultation, though, it’s important that you work with a doctor who is trained to help you treat and manage this chronic condition.
